Title: Sirt3 mediated by lentiviral vector in the periaqueductal gray suppresses morphine withdrawal in rats: A preliminary study Shue Liu*, Hyun Yi*, Jun Gu, Daigo Ikegami, Kentaro Hayashi, and Shuanglin Hao Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL, USA; Corresponding address: Dr. Shuanglin Hao, Professor & Director of Preclinical and Basic Research Department of Anesthesiology, University of Miami Miller School of Medicine, 1550 NW 10th Ave, Fox BLDG, Rm 210 Miami, FL33136 Tel: 305-243-6420 (O), Fax: 305-243-9160 (O) Email: [email protected] * Contributed equally to the study. CONFLICT OF INTEREST The authors declare no conflict of interest.
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Abstract Opioid use disorder (OUD) is a significant clinical and social problem, inducing
dependence/addiction and over-dose death. Opioid dependence/withdrawal contributes to the
addiction vulnerability. Limited understanding of the exact mechanisms of morphine withdrawal
leads to failure to adequately manage opioid withdrawal symptoms. Determining new molecular
mechanisms of morphine withdrawal (MW) may allow development of novel therapeutic
strategies for treating this disorder. Chronic morphine with naloxone precipitation induces MW
behavioral response. Sirt3 (one member of sirtuins family) as a mitochondrial fidelity, plays an
important role in mitochondrial homeostasis through the direct regulation of mitochondrial energy
metabolism, ATP synthesis, detoxification of mitochondrial ROS, etc. In the pilot study, we found
that (1) cultured neurons infected with lentiviral vector expressing Sirt3 induced over-expression
of Sirt3, (2) microinjection of LV-Sirt3 into the vlPAG increased Sirt3 protein expression in rats,
(3) MW lowered the expression of Sirt3 in the vlPAG, and (4) microinjection of LV-Sirt3 into the
vlPAG decreased the MW behavioral response. Current preliminary study demonstrates that
complement of Sirt3 in the PAG suppressed MW, providing a novel therapeutic approach to
morphine physical withdrawal symptoms. The exact up-and/or down-stream factors of Sirt3 in the
model are under the investigation.
Keywords: Sirt3, morphine withdrawal, PAG
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1. Introduction Opioid use disorders (OUD) have reached an epidemic level in the United States 1. Opioid use
disorder (OUD) is a significant clinical and social problem, inducing dependence/addiction and
over-dose death2. CDC Morbidity and Mortality Weekly Report shows that from 2016 to 2017,
synthetic opioid-involved overdose death rates increased 45.2% 3. Repeated opioid use induces
hyperalgesia, tolerance, dependence and addiction 4-8. There is an increased risk of overdose death
with higher daily opioid doses for increasing analgesic effect 9. Opioid physical dependence is one
of the determinants of opiate abuse in dependent individuals. Physical dependence to opiates can
be demonstrated by either termination of drug administration or opiate antagonist precipitation of
the withdrawal syndrome. Existing pharmacotherapies for opioid dependence management may
have high rates of failure (e.g. relapse and/or dropout)10, 11 because the exact mechanisms of opioid
dependence are still poorly understood.
Neuropharmacological studies show that several regions (e.g. locus ceruleus (LC),
periaqueductal gray (PAG)) of the brain with high opioid receptors, are related to MW or drug
abuse 12-14. Functional and anatomical studies have implicated an important role for the PAG in
opioid withdrawal 15-18. Sirtuins are protein deacetylases dependent on nicotine adenine
dinucleotide (NAD) in organisms ranging from bacteria to humans19. In mitochondria, some
specific fidelity proteins activate signaling pathways to maintain mitochondrial homeostatic poise.
Sirtuin 3 (Sirt3, one of sirtuins family), a major deacetylase in mitochondria, is essential in
maintaining mitochondria homeostasis. Sirt3 is localized into the inner mitochondrial membrane.
Sirt3, a fidelity protein for mitochondrial function activity 20, has recently received great attention,
however, its role in the PAG in MW is still not clear.
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In the preliminary study, we used lentiviral vector-mediated expression of human Sirt3 to
determine the effect of Sirt3 overexpression in the ventrolateral PAG (vlPAG) on naloxone-
precipitated MW in rats. In the near future, we will determine the exact molecular mechanisms of
up-and down-stream pathway of Sirt3 in the model.
2. Materials and methods Construction of the lentiviral vector expressing Sirt3
We constructed a lentiviral vector, human Sirt3 expressing lentiviral vector with lentiviral
plasmid, packaging plasmid, and VSV-G envelope generated by inserting human Sirt3 plasmid
(Purchased from Addgene #13814) into HIV.SIN.cPPT.CMV.eGFP.WPRE (Purchased from U
Penn Vector Core, Philadelphia, PA) at the EcoIR site (LV-Sirt3, packaged by Dr. Mingjie Li,
Neurology, Washington University School of Medicine, St. Louis, MO). Control lentivirus (LV-
GFP) was made but no human sirt3 gene.
Animal and evaluation of chronic morphine physical dependence
Male 7-8 weeks Sprague-Dawley rats (body weight 225-250 g) were housed two per cage
approximately 1 week prior to the beginning of the research, with free access to food and water
and maintained on a 12:12, light: dark schedule at 21 ◦C and 60% humidity. All housing conditions
and experimental procedures were approved by the University Animal Care and Use Committee.
Morphine withdrawal procedure was induced as described previously 21. Rats received escalating
doses of intraperitoneal (IP) morphine for a period of 5 days as follows: day 1, 10 mg/kg (8AM,
IP) and 15 mg/kg (8PM); day 2, 20 and 25 mg/kg; day 3, 30 and 35 mg/kg; day 4, 40 and 45
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mg/kg. On day 5, animals received a morning injection of 50 mg/kg, and 1 hour later, naloxone
(4 mg/kg, IP) was administered to precipitate a MW response. Rats were placed individually in a
test chamber (50×35×45 cm) immediately after naloxone, and we evaluated MW behavioral signs
over the course of 30 min. Two types of signs were measured during abstinence, as described
previously 22, 23. Episodes of wet-dog shakes and jumps were counted (i.e. recorded quantitatively);
teeth chatter (vacuous chewing), diarrhea, rhinorrhea, ptosis, lacrimation, escaping, penile
erection, and abnormal posture were evaluated over 5 min periods with one point being given for
the presence of each sign during each period. We recorded the body weight of each rat before the
injection of naloxone and then again at 60 min after naloxone. The scored signs defined in our
previous work24, were based on our previous experience as modified from those described by
Punch et al 13. A global withdrawal score was calculated for each rat by assigning a combination
of the various physical signs of withdrawal 25. MW behavior counting were carried out by a
blinded operator.
Microinjection of lentiviral vector into vlPAG
For intracranial vector administration, anesthetized rats with isoflurane were placed in a
stereotaxic headholder (David Kopf Instruments, Tujunga, CA). After the skull was exposed, a 33-
gauge needle with microsyringe was directed bilaterally toward the vlPAG (AP -8.2 mm using
bregma as 0, ML ±0.75 mm, DV -6.2 mm from the base of the skull). Rats were randomly divided
to receive a bilateral vlPAG injection of LV vector expressing Sirt3 (LV-Sirt3, 1 µl of LV-GFP
(3.4x108 IU/ml)) or control vector expressing GFP (LV-GFP) with a micropump (0.5µl/min). After
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injection, the injector was left in situ for an additional 4 min before it was removed. Animals
showing neurological deficits or 85 % loss of body weight after microinjection were excluded.
Western blot
Rat brains were harvested under deep anesthesia. A tissue block including a segment at the level
of the vlPAG was cut on an ice cold glass plate 16. The vlPAG from the tissue block was harvested
by taking punches with a 14 gauge puncture needle as described previously 26. The punched vlPAG
tissue was homogenized with 100 µl of ice-cold lysis buffer (150 mM sodium chloride, 1.0% NP-
40, 0.5% sodium deoxycholate, 0.1% SDS, 50 mM Tris, pH 8.0) containing protease inhibitors
(Sigma, St Louis, MO) and phosphatase inhibitor cocktail 2 and 3 (Sigma, St Louis, MO). We
sonicated tissue for homogenates and then centrifuged it at 15,000 g for 20 min at 4 oC. The
supernatant was collected and assayed for protein content using the BCA assay method (Pierce,
Rockford, IL, USA) and stored at -80 oC until further use. Protein (~20 µg) was electrophoresed
on a 12% SDS-PAGE gel, then transferred to a PVDF membrane, and blocked with 1x Rapid block
solution (Amresco, Fountain Parkway Solon, OH) at room temperature for one hour. The primary
antibodies, rabbit anti-Sirt3(cata#2627, 1:2000, Cell signaling, Danver, MA) and mouse β-
actin(cata#A5441, 1:8000, Sigma, St. Louis, MO) were incubated overnight at 4 oC in fresh
blocking buffer. The membrane was washed and incubated with complementary secondary
antibodies (1:4000, horseradish peroxidase conjugated IgG antibody, Santa Cruz biotechnology,
Dallas, TX) for 1 h at room temperature. The membranes were washed in washing buffer for 10
minutes three times and the antibodies were then revealed using Super Signal west dura extended
duration substrate (Thermo Fisher Scientific Inc, Rockford, IL, USA). For densitometric analyses,
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blots were quantified with Quantity One analysis software (Bio-Rad, Hercules, CA). The results
were expressed as the ratio to β-actin immunoreactivity.
Immunohistochemistry
For the PAG immunohistochemistry, rats were perfused intracardially with 4% PFA in 0.1 M
phosphate buffer, and the brains were removed, postfixed in the same solution for overnight, and
cryoprotected with 30% sucrose in phosphate-buffered solution for 2 days. In order to define the
co-localization with NeuN, Sirt3, GFAP, or Iba1, cryostat sections (25 μm thickness) were
incubated 48 h at 4 °C with primary antibodies, mouse anti-NeuN (cata #MAB377, 1:500,
Millipore, Billerica, MA ), rabbit anti-Sirt3(cata#2627, 1:100, Cell signaling, Danvers, MA),
mouse anti-GFAP (cata. # G3893, 1: 3000, Sigma, St Louis, MO), and rabbit anti-Iba1 (cata.#
019-19741, 1:2000, Wako, Richmond, VA) followed by fluorescent IgG with Alexa Fluor 488 or
594 (1:1000, Invitrogen Life Technologies) for 2 hours at room temperature. Fluorescence images
were captured by a fluorescent microscopy (Fluorescent M Leica/Micro CDMI 6000B).
Sirt3 expression in cultured neuronal cells treated with lentiviral vectors
The rat neuronal cell line (B35, CRL-2754) was obtained from American Type Culture
Collection (ATCC, Manassas, VA). For western blots, the cells were plated in a 6-well plate,
infected with either LV-Sirt3 or LV-GFP at a multiplicity of infection (MOI, =1) for 3 days, and
collected to measure human Sirt3 expression using western blot.
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Drugs and data analysis
Morphine sulfate was obtained from West-Ward Pharmaceuticals, Eatontown, NJ. Naloxone
hydrochloride was obtained from Sigma. Naloxone was injected intraperitoneally in a volume of
1 ml/kg of body weight. All drugs were dissolved in physiologic (0.9%) saline. The sample size
estimate was based on our previous studies16, 27. The statistical significance of the differences was
determined by one-way ANOVA (SPSS21, IBM, Armonk, NY, or StatView5, SAS Institute Inc.
Cary, NC), or t test. The difference between the time-course curves of MW behavior was
determined using 2-way ANOVA repeated measure (GraphPad Prism 5). P-values of less than
0.05 were considered to be statistically significant.
3. Results 3.1. Sirt3 expression mediated by lentiviral vectors in vitro and in vivo
Three days after transfection with LV-Sirt3 or control vector LV-GFP, neurons were collected,
and Sirt3 were detected by western blot. We found that Sirt3 expression in neurons infected with
LV-Sirt3 was significantly higher compared to LV-GFP (Figure 1).
In in vivo study, Figure 2A showed that the track of vlPAG injection was cleanly seen at the
vlPAG, marked with red ellipse. To evaluate the expression of Sirt3 mediated by LV-Sirt3, 2 weeks
after microinjection of LV-Sirt3 into the vlPAG, the vlPAG tissue was collected, and Sirt3
expression was compared using western blot. Western blot showed that Sirt3 expression in LV-
Sirt3-microinjected animals was higher compared to LV-GFP (Figure 2B).
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3.2. MW lowered the expression of Sirt3 at the vlPAG
We have reported that chronic escalating morphine with naloxone precipitation induced
morphine withdrawal response 16. It is suggested that oxidative stress is involved in the
development of morphine physical dependence. Heroin decreased the total antioxidant capacity of
serum and the anti-oxidative enzymes activities in brains 28. Sirt3 can rescue neuronal loss in
various neurodegenerative models 29. Loss of Sirt3 increases mtO2●- levels, whereas
overexpression of Sirt3 decreases mtO2●- levels 30, 31. Our unpublished data showed that MW
increased mitochondrial superoxide in the vlPAG. Here, in chronic morphine with naloxone
precipitation model, we observed that Sirt3-immunoreactivity expression mainly was co-localized
with NeuN (a marker of neurons) (Figure 3B-D), but not GFAP (a marker of astrocytes) or Iba1
(a marker of microglia) (data not shown). Western blots demonstrated that the expression of Sirt3
in MW group was lower than that in the sham group (Figure 3E).
3.3. Neuronal-targeting GFP expression mediated by lentiviral vectors microinjected into the
rat PAG
We constructed the lentiviral vector to express human sirt3 gene (LV-Sirt3). Control vector
contains gfp gene but no human Sirt3 gene (LV-GFP). We microinjected LV-GFP into the PAG.
Ten days after injection, rats were perfused with 4% PFA. The direct green fluorescence was
detected, and GFP was co-localized with NeuN immunostaining (Figure 4), but not glia markers
GFAP or Iba1 (Figure 4).
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3.4. Lentiviral vector-mediated expression of Sirt3 suppressed MW behavioral response
LV-SIRT3 or LV-GFP was bilaterally microinjected into the vlPAG. For MW induction, ten
days after vector microinjection, chronic escalating morphine or vehicle (sham) was administered.
At day 5 of chronic morphine, one hour after the last injection of morphine, animals received
naloxone. Withdrawal scores were calculated for each rat immediately after naloxone. In sham
groups with microinjection of LV-Sirt3 or LV-GFP, there was no significant difference in the MW
behavior scores (Figure 5).
There was a significant increase in behavioral scores of teeth chat (Figure 5B), ptosis (Figure
5C), abnormal posture (Figure 5D), explore running (Figure 5E), wet-dog shakes (Figure 5F), body
weight loss (Figure 5G), and global scores (Figure 5H) in rats with LV-GFP/MW compared to
LV-GFP/sham rats. MW behavioral scores of teeth chat, ptosis, abnormal posture, explore running,
wet-dog shakes, body weight loss, and global scores in the LV-Sirt3/MW group, were significantly
lower than that in the LV-GFP/MW group (Figure 5B-H). For the comparison of the time course
of MW behavioral response, 2-way ANOVA Bonferroni test showed that there was a significant
increase in MW behavioral global scores in the LV-GFP/MW rats compared to the LV-GFP/sham
group at time points of 5-30 min (P < 0.01) (Figure 5I), and that MW global scores in the LV-
Sirt3/MW group were significantly lower than that in the LV-GFP/MW group (Figure 5I).
4. Discussion OUD is a significant clinical and social problem, inducing dependence and over-dose death2.
Elucidation of the exact mechanisms of MW is important to treatment of opioid dependence. In
the pilot study, we found that (1) cultured neurons infected with lentiviral vector expressing Sirt3
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induced over-expression of Sirt3, (2) microinjection of LV-Sirt3 into the vlPAG increased Sirt3
protein expression in rats, (3) MW lowered the expression of Sirt3 in the vlPAG, and (4)
microinjection of LV-Sirt3 into the vlPAG decreased the MW behavioral response.
Neuropharmacological studies show that multiple regions of the brain with high opioid receptors,
are related to MW or drug abuse in human and animals 13, 15, 32-41. Anatomical, and neurochemical
studies have implicated an important role of the PAG in opioid withdrawal 15-18, 42-44. Distinct PAG
columns project to midline and intralaminar thalamic regions 45. The lateral hypothalamic area
projects selectively to the vlPAG 46. PAG projecting to several regions of the brain including the
locus ceruleus (LC), may function as an integrating center to coordinate responses to opiate
withdrawal 47.
Sirtuins are NAD+-dependent class III histone deacetylases, and they are present from bacteria
to humans48. The mammalian sirtuins are related to wide activities including cellular stress
resistance, genomic stability, gene silencing, tumorigenesis, and energy metabolism 49. Sirtuins
are involved in cellular and nutrient stress inducing the activation of their deacetylase or
ribosyltransferase activity48, 50. The sirtuins primarily target cellular proteins to regulate cell
signaling networks 49 and post-translationally alter the activity of downstream protein targets51.
Sirtuin activating compounds slow metazoan ageing by mechanisms that may be related to caloric
restriction 52. Sirtuins modulate p53-mediated growth regulation53. Mammalian sirtuins contain 7
sirtuins (Sirt1-7) localized in the nucleus (Sirt1, 6, 7), cytoplasm (Sirt2), and mitochondria (Sirt3-
5) 54. Sirt3 is the primary mitochondrial sirtuins. Calorie restriction reduces oxidative stress by
Sirt3-mediated MnSOD activation 55. SIRT3(-/-) mouse embryonic fibroblasts (MEFs) exhibit
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abnormal mitochondrial physiology as well as increases in stress-induced superoxide levels and
genomic instability, suggesting that SIRT3 is a genomically expressed, mitochondria-localized
tumor suppressor 56. Mitochondria from Sirt3(-/-) animals display a selective inhibition of
mitochondrial respiratory chain complex I activity; incubation of exogenous Sirt3 with
mitochondria can augment Complex I activity, implicating that Sirt3 functions in vivo to regulate
and maintain basal ATP levels57. Sirt3 as a mitochondrial fidelity maintains mitochondrial
homeostasis through the direct regulation of mitochondrial energy metabolism, ATP synthesis,
detoxification of mitochondrial ROS, etc.
Sirt3 is expressed at high levels in the central nervous system 29 and regulates every major aspect
of mitochondrial biology, including reactive oxygen species (ROS) detoxification and
mitochondrial dynamics 58-60. Superoxide radical (O2●-) can react with DNA, lipids, etc., to
ultimately result in cell injury 61. Mitochondria are the major source of intracellular ROS in neurons
62. Sirt3 deacetylates MnSOD and thereby activates it for scavenging mtO2●- 30, 63-65. Loss of Sirt3
increases mtO2●- levels, whereas overexpression of Sirt3 decreases mtO2
●- levels 30, 31. Sirt3 can
rescue neuronal loss in various neurodegenerative models 29. Our current study demonstrates that
MW decreased expression of Sirt3 in the PAG.
Oxidative stress is involved in the development of morphine physical dependence. Heroin
decreased the total antioxidant capacity of serum and the anti-oxidative enzymes activities in
brains 28. Pretreatment with antioxidants could inhibit oxidative stress, and alleviate opioid
withdrawal in animals 66-68. Our unpublished data shows that MW increased the mitochondrial
superoxide in the vlPAG and super-oxidative scavenger reduced MW behavioral response. We
reported that herpes simplex viral vector over-expressing MnSOD in the vlPAG reduced MW
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behavioral response 69. It is highly possible that Sirt3 mediated by the lentiviral vector suppressed
MW behavioral response through activating MnSOD.
Future study
The pilot studies show that MW lowers neuronal Sirt3 expression in the PAG, suggesting that
loss of sirt3 play an important role in the MW, however it is still not clear about the upstream
pathway of Sirt3 loss. Our unpublished data showed that Sirt3 was mediated by EZH2 or miRNA
in an epigenetic manner in chromic morphine or neuropathic pain state. Recent report shows that
SUMO-specific protease SENP1 is accumulated in mitochondria and quickly de-SUMOylates and
activates Sirt3 70. Sirt3 also mediates the function/activity of MnSOD 55, 71. In the near future, we
will determine the exact mechanisms of Sirt3 up-stream and down-stream factors in chromic
morphine or neuropathic pain state.
Acknowledgements: Supported by grants from the US National Institutes of Health
R01NS066792 (S.H.), R01DA34749 (S.H.), R01DA047089 (S.H.), R01DA047157 (S.H.),
The legend of Figures
Figure 1. Sirt3 expression mediated by lentiviral vectors in vitro. Three days after transduction
with LV-Sirt3 or control vector LV-GFP (A), neurons were collected, and Sirt3 was detected by
western blot (B). Sirt3 expression in neurons infected with LV-Sirt3 was significantly higher
compared to LV-GFP, **P<0.01, t test, n=6.
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Figure 2. Sirt3 expression mediated by lentiviral vectors in vivo. (A) The track of vlPAG
injection was cleanly seen at the vlPAG, marked with red ellipse. (B) Western blot showed that
substantial amounts of Sirt3 in LV-Sirt3-microinjected animals compared to LV-GFP, 2 week after
microinjection of LV-Sirt3 into the vlPAG, **P<0.01, t test, n=4-5.
Figure 3. MW lowered Sirt3 expression in the vlPAG. (A) The MW procedure was shown. (B-
D) Double immunostaining showed that Sirt3-immunoreactivity mainly was co-localized with
NeuN (a marker of neurons). (E) Western blots demonstrated that the expression of Sirt3 in MW
group was lower than that in the sham group, **P<0.01, t test, n=6 (Figure 3D). nal, naloxone.
Scale bar, 50µm.
Figure 4. Neuronal-targeting GFP expression mediated by lentiviral vectors microinjected
into the rat PAG. (A) The LV microinjection and the MW procedure was shown. (B-E) We
microinjected LV-GFP into the PAG. Ten days after injection, rats were perfused with 4% PFA.
The direct green fluorescence was detected, and GFP was co-localized with NeuN
immunostaining, but not glia markers GFAP (F) or Iba1 (G). LV, lentiviral vector; IP,
intraperitoneal injection. Scale bar, 50µm.
Figure 5. Lentiviral vector-mediated expression of Sirt3 suppressed MW behavioral
response. (A) The LV microinjection and MW procedure was shown. Lentiviral vector LV-SIRT3
or LV-GFP was bilaterally microinjected into the vlPAG. For MW induction, ten days after vector
microinjection, chronic escalating morphine or vehicle (sham) was administered. At day 5 of
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chronic morphine, one hour after the last injection of morphine, animals received naloxone. There
was a significant increase in MW behavioral scores of teeth chat (B), ptosis (C), abnormal posture
(D), explore running (E), wet-dog shakes (F), body weight loss (G), and global scores (H) in rats
with LV-GFP/MW compared to LV-GFP/sham rats. MW behavioral scores of teeth chat, ptosis,
abnormal posture, explore running, wet-dog shakes, body weight loss, and global scores in the LV-
Sirt3/MW group, were significantly lower than that in the LV-GFP/MW group, one-way ANOWA
Bonferroni test. (I) The time course of MW behavioral response, **P<0.01 vs. LV-GFP/sham,
#P<0.05, ##P<0.01 vs. LV-Sirt3/MW, 2-way ANOVA Bonferroni test, n=5.
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